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April 1, 2020

Research News Roundup–March 2020

By Elizabeth Zimmermann

Even though it's April Fool's Day, the stories we share in this monthly column are no joke. Because since last month our world has shifted focus, we've divided these releases into two sections - COVID-related, and everything else.

"Everything else" is at the end this month, because it is the bigger section, with nearly a dozen stories out in the first half of March. We should note that although a wide variety of health care and biomedical research, as well as research education, continues at Mayo Clinic, most communication activities have since shifted focused to supporting content regarding COVID-19 concerns for patients, staff and community.

SARS-CoV-2, the virus that causes COVID-19, continues to spread, leading to more than 20,000 deaths worldwide in less than four months. Efforts are progressing to develop a COVID-19 vaccine, but it's still likely 12 to 18 months away.

In the meantime, the pandemic, with over 400,000 confirmed cases worldwide already, is driving researchers to find safe and effective therapies for patients with COVID-19, and an antimalarial drug is potentially on the front lines of that effort. While new and repurposed drugs are being tested in clinical trials, some of these promising drugs are simultaneously being used off-label for compassionate use to treat patients.

Some of the medications being used to treat COVID-19 are known to cause drug-induced prolongation of the QTc of some people. The QTc is an indicator of the health of the heart's electrical recharging system. Patients with a dangerously prolonged QTc are at increased risk for potentially life-threatening ventricular rhythm abnormalities that can culminate in sudden cardiac death.

Mayo Clinic has significantly expanded its capacity to test clinical samples for SARS-CoV-2, the virus that causes COVID-19. With new equipment that went online Tuesday, Mayo Clinic Laboratories now has the capacity to process COVID-19 test samples from all Mayo Clinic sites. In addition, it has begun processing test samples from its clients across Minnesota, including eight major health systems.

"The capability to test and process clinical samples for the SARS-CoV-2 virus is urgently needed nationwide and we have been working around the clock to make this expansion happen as quickly as possible," says William Morice, II, M.D., Ph.D., president of Mayo Clinic Laboratories and chair of Mayo Clinic’s Department of Laboratory Medicine and Pathology. "Our expanded capacity will expedite caring for patients at this critical time, and hopefully will ease the burden being felt at test processing laboratories in Minnesota and a growing number of geographies."

Mayo Clinic has developed a test that can detect the SARS-CoV-2 virus in clinical samples. The SARS-CoV-2 virus causes COVID-19.

The test, "Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2), Molecular Detection" has been fully validated. Data from this test will be submitted to the Food and Drug Administration for review and emergency use authorization.

Homelessness has become a social crisis and public health problem around the world, affecting people of all ages. Most homeless people are at a disadvantage with few resources, and may or may not have adequate health insurance. Mental illness and substance abuse are common issues in the homeless community. People living on the streets have a high likelihood of developing heart disease. Yet they have little ability to take care of their health.

A new study published in Mayo Clinic Proceedings examined in-hospital outcomes and 30-day readmission rates of 3,937 homeless patients from more than 1.5 million people admitted for a heart attack. Researchers used two years of data (2015–2016) from the National Readmission Database. The findings show that homeless patients often receive less treatment and are more likely to end up readmitted to the hospital within a month.

"To be included as one of the top medical schools in the country is a real testament to the tremendous educational efforts of our faculty, students and staff," says Fredric Meyer, M.D., Waugh Executive Dean for Education, Mayo Clinic. "It also recognizes the strong bonds between Practice, Research and Education at Mayo Clinic, and how we work together to face head-on the medical challenges that will present to our school, our institution and the patients we serve now and in the future."

Almost two-thirds of surgeons reported an increase in neck pain after performing surgery, and one-quarter rated their neck or lower back pain as clinically significant, a new Mayo Clinic study has found. The research was published in the Journal of American College of Surgeons.

Older adults who have surgery with general anesthesia may experience a modest acceleration of cognitive decline, even years later. But there's no evidence of a link to Alzheimer's disease, according to new research from Mayo Clinic.

The research, published in the British Journal of Anaesthesia, examined brain scans from 585 patients, ages 70 to 91 ― 493 of whom had at least one surgery with general anesthesia. The analysis found cortical thinning in cerebral areas but no significant evidence of deposits of amyloid protein, a hallmark of Alzheimer's disease. The cortex is the outermost layer of the brain's nerve cell tissue, and thinning of that tissue is associated with diminished cognitive functions.

Mayo Clinic researchers have uncovered stem cell-activated mechanisms of healing after a heart attack. Stem cells restored cardiac muscle back to its condition before the heart attack, in turn providing a blueprint of how stem cells may work.

The study, published in NPJ Regenerative Medicine, finds that human cardiopoietic cells zero in on damaged proteins to reverse complex changes caused by a heart attack. Cardiopoietic cells are derived from adult stem cell sources of bone marrow.

Only 1 in 13 everyday patients could have participated in a pivotal international clinical trial looking at the use of catheter ablation to treat atrial fibrillation (AFib) among people with heart failure. However, new Mayo Clinic research provides evidence supporting the benefit of ablation, and shows what the outcomes might be for everyday patients. The Mayo study was published in Heart Rhythm Journal.

The Catheter Ablation for Atrial Fibrillation with Heart Failure (CASTLE-AF) trial compared catheter ablation versus medical therapy alone for atrial fibrillation in patients with heart failure. In early 2018, the results of that trial were announced. Although the trial was fairly small with 363 participants, it showed an impressive 38% reduction in risk of death or hospitalization for worsening heart failure.

The toxic protein tau is a key biological feature in the brains of people with Alzheimer's disease. Yet the factors that make people susceptible or resistant to tau accumulation are not well-understood. A preliminary Mayo Clinicstudy shows that inherited DNA variants may be associated with developing tau deposits in older adults.

The density of immune cells, called tumor infiltrating lymphocytes, when combined with analysis of tumor budding may serve as a method to more accurately predict survival in patients with stage III colon cancer. The findings, by a team of researchers led by Mayo Clinic gastroenterologist and oncologist, Frank Sinicrope, M.D., were published March 2 in Annals of Oncology.

Using colon cancer tissues from a completed clinical trial, Dr. Sinicrope and his colleagues were able to demonstrate that the extent or density of tumor infiltrating lymphocytes (TILs), reflecting the patient’s anti-tumor immune response, is a robust predictor of survival in patients with stage III colon cancer. TILs are a type of immune cell that has moved from the blood into a tumor that can recognize and kill cancer cells.

A study by researchers at Mayo Clinic published March 3 in the Journal of Clinical Oncology suggests that all women with a breast cancer diagnosis under the age of 66 be offered germline genetic testing to determine if they have a gene mutation known to increase the risk of developing other cancers and cancers among blood relatives. Current guidelines from the National Comprehensive Cancer Network (NCCN) recommend germline testing for all women diagnosed with breast cancer under the age of 46 regardless of their family history and breast cancer subtype.

Chronic pain affects a large proportion of older adults and most long-term care residents. Managing chronic pain effectively is essential but challenging, and it has been complicated by concerns about opioid abuse.

Pain management can be safely optimized with a plan that balances the risks and benefits of treatments, according to a commentary in Mayo Clinic Proceedings. Treating chronic pain is best achieved when pharmacologic strategies and nondrug therapies are used at the same time.

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